Racism causes high infertility in Black women

Black women experience infertility twice more than white ones.
Black women experience infertility twice more than white ones.
Image: Reuters/Shannon Stapleton
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There persists an old, racist myth that Black women are somehow exceptionally fertile.

This is a misconception scientists helped perpetrate, establishing without evidence in the early 1900s that Black women were more likely to become pregnant than women of other races. In 1932, for instance, the journal Birth Control Review wrote in an issue devoted to Black fertility that “the present submerged condition of the Negro is due in large part to the high fertility of the race,” notes Edna Bonhomme, a historian of science at Bard College Berlin.

This myth of Black hyper-fertility has been internalized within Black communities, too, and it’s still largely alive today across society. So much so that it’s contributing to making the opposite true: Black women are actually twice as likely as white women to suffer from infertility, according to the most recent data from the Centers of Disease Control and Prevention (CDC), both from primary infertility (an inability to become pregnant) and secondary infertility (an inability to become pregnant after having conceived in the past).

There are several reasons behind the higher infertility—defined by the CDC as the inability to achieve pregnancy within 12 months while having at least monthly unprotected sex for women below 35, and six months for women 35 and above—among the Black population. Some are biological, such as a higher incidence of uterine fibroids, which are the cause of about 15% cases of infertility and occur more frequently in Black women. Tubal factor infertility, too, the result of issues with fallopian tubes or even tubal ligation surgery, is more frequent among Black women.

But there are systemic factors, too, many of which linked to racism, according to Rashmi Kudesia, a doctor specializing in reproductive health and infertility at CCRM, one of the main US providers of fertility treatments.

Black women of fertile age are also more likely to have chronic comorbidities—such as diabetes, or obesity—which are linked to lack of access to healthcare, and other social determinants of health, including education level and socioeconomic status, which are often the result of systemic racism.  Factors like hormonal imbalances or irregular ovulation tend to affect Black women more. “Increasingly there is a recognition that some of that may have to do with the chronic stressors of systemic racism in the country and the many micro- and macro-aggressions that Black women experience,” says Kudesia.

But two non-physiological factors are especially impactful, and both of them can be linked with the hyper-fertility myth. First, Black women tend to seek medical help for infertility later than white ones. This is in some measure connected with distrust of the medical field and hesitancy in discussing fertility issues, but a major factor, too, is the belief that fertility issues don’t affect Black women. “There’s this misconception that Black women are just more fertile naturally,” says Kudesia. “I have heard that stated by medical professionals, by my own patients that are Black women.”

A study published in 2015 in the journal Psychology of Women found that the myth of high fertility was persistent among Black women across socioeconomic and education levels. This leads them to delay care, making them half as likely as white women to seek fertility treatment, even aside from potential financial barriers to care.

Another important factor in high infertility, however, is the fact that Black women are twice as likely as white women to undergo tubal ligation, a form of surgical sterilization, and especially young. While about 10% of unmarried white women below 30 have had the procedure, 31% of Black ones have. Women who have had tubal ligation, even if sought voluntarily, are considered infertile by the CDC if they would like to conceive again.

This is in part, once again, because of the perception of hyper-fertility among Black women who often get surgical sterilization after having children in their 20s, says Kudesia. But counseling sterilization has a loaded history in the US, where it was historically used to control the Black population, at times with racist intent and at others, with the support of Black intellectuals, with the belief it would be a tool of empowerment. Black women were counseled toward ligation more frequently, out of the belief their supposed hyper-fertility would be socially and economically damaging.

As a result of this history, ligation is so prevalent among Black women that it’s often the default contraceptive method they turn to. Yet in many cases, these women lack a complete and clear understanding of the consequences of tubal ligation. A 2014 study found that 62% of African American women think fertility is easily restored after tubal ligation (32% of white women thought so) and 60% thought tubal sterilization would reverse after five years (compared to 23% white women). In reality, while reversal is possible in some cases, the procedure is by-and-large permanent.